The potential effect of the updated national criteria on adult cochlear implantation in England and Wales

Abstract

Objectives

Following an update of ‘old’ TA166 guidance (March 2019), the National Institute for Health and Care Excellence (NICE) predicted a 70% increase in cochlear implantation (CI). We investigated the effect of the ‘new’ TA566 criteria on adult CI at our regional centre.

Methods

Adult CI assessments between 1st January 2015 and 31st December 2018 (before new criteria) and between 7th March 2019 and 31st August 2019 (after new criteria) were retrospectively examined. Calculated eligibility and uptake rates predicted change in annual implantation under the new guidance.

Results

552 patients were identified in the first study period, with a median of 148 assessments per year. Of 533 with complete assessments, 58% were eligible, of whom 74% were implanted. Retrospective application of the new criteria was possible for 277 patients; eligibility and uptake were 67% and 80%, respectively. In the second study period (n = 60), new criteria eligibility was 62% and uptake was 78%. Increased eligibility under the new criteria predicts an increase of between 13 and 23% in annual adult implantation.

Conclusions

We demonstrate increased implant eligibility under the latest NICE guidance. Assuming consistent referral patterns, our predicted increase in adult implantation is considerably less than that predicted elsewhere.

Keywords:

• Adult
• Deafness
• Hearing Loss
• Cochlear Implantation
• Standards

Additional information

Notes on contributors

James D. Constable

James D. Constable graduated in Chemistry (BSc) at the University of Warwick in 2009, before graduating in Medicine (BMBS) at the University of Nottingham in 2013. He then started his clinical training in the East Midlands, before taking up his current specialty otolaryngology training post in the South West of England in 2018. Mr Constable is interested in collaborative research, and is current chairperson of the INTEGRATE UK ENT Trainee Research Network Head & Neck Committee. He is studying towards a Masters degree to further advance his interests in healthcare quality improvement and development.

Stephen J. Broomfield

Stephen J. Broomfield completed his basic surgical training and ENT registrar training in Manchester. He subsequently completed a 6-month fellowship in Sydney, Australia in the field of implantation otology and balance disorders. This was followed by a further period of higher surgical training in implantation otology and middle ear disease in Nottingham. Mr Broomfield was appointed as an ENT consultant in Bristol in 2011 and specialises in all areas of paediatric and adult otology, including middle ear disease, hearing loss, auditory implants and balance disorders.

Elisa Romeo

Elisa Romeo graduated with a BSc in Psychology from York University in 2006. She went on to complete postgraduate training in Audiology at the University of Southampton and, through the Scientist Training Programme, at the University of Manchester. She has completed research projects on bone conduction and dual sensory impairment. Elisa has worked in the adult service at the West of England Hearing Implant Programme since 2015.

Philip J. Clamp

Philip J. Clamp trained in Oxford before completing higher surgical training in the Southwest. He undertook a clinical and research fellowship in Melbourne, Australia. This fellowship focused on the management of complex ear disease, cochlear implantation and lateral skull base surgery. The University of Melbourne and Royal Victorian Eye and Ear Hospital are world renown for the development of cochlear implants. He completed research projects on the effect of implantation on cochlear mechanics and novel bone-anchored hearing aids. Mr Clamp was appointed as a consultant in 2014. He has a specialist interest in adult and paediatric otology, hearing implants and lateral skull base surgery. He is based at St Michaels and the Children’s Hospitals. He is a core member of the regional skull base MDT with additional clinics and operating sessions at Southmead Hospital. Mr Clamp has an interest in ENT research and is an honorary clinical lecturer at the University of Bristol.